Ignorance and issue of hygiene in rural Rwanda

NYAMAGABE - Martha Nizeyimana’s two-and-half-year-old son was recently taken to Nyamagabe Health Centre, vomiting and suffering from bloody diarrhoea. Nurses quickly figured out he had intestinal worms, just like his three elder siblings before him. They ordered Vermox and Nystatin syrups to de-worm him, and acid tablets to ease his pain. This situation is repeated around the country every day, every night. At least 65 per cent of all Rwandans suffer from intestinal worms, according to new research completed last month by the country’s Neglected Tropical Diseases (NTD) programme. The parasites cause diarrhoea that is a leading cause of death among children in developing nations, according to Action Against Hunger. Despite this danger, the disease does not receive as much attention as malaria, HIV/AIDS or Tuberculosis. However, this year the government will launch a major education campaign to eradicate the disease. Martha Nizeyimana suspects malnutrition is the cause of the parasites’ infection on her children. Though, the disease does not come from malnutrition. It instead causes it. The parasites are found in communities with poor hygiene where human faeces get into soil or water used for drinking and irrigating crops. Dirty hands also spread parasite infestation. Intestinal worms cause persistent diarrhoea that leads to dehydration, malnutrition, weight loss, stomach pain, loss of blood in bodily excretions leading to death. No wonder Nizeyimana and her husband always expect to take their children to a hospital for de-worming at any time. The family is exposed to easy contamination. Their kitchen is two meters from their pigs stable. The toilet and the cows stable are nearby. “We do our best but it is too difficult for us to ensure the hygiene,” explains Nizeyimana’s husband. He said his children used to play in an area near the kitchen and the pigs, yet he cannot always be around to monitor them. All four of Nizeyimana’s children have been regularly visiting Nyamagabe Health Centre for similar cases “We can’t escape these worms in this rural area,” she said, while feeding her son, sometimes with a spoon, sometimes with hands that she had not bothered to wash since arriving home from the hospital. “We can’t get a complete diet and …we are too poor,” she laments. Her husband does not agree that the family lacks enough to eat. Munyaneza says, he makes sure they eat enough oil and vegetables and he does not believe that his family lacks vitamins. “I can not go to the bar when I didn’t buy enough food for my children,” he said. He thinks the contamination is encouraged by the way his wife cooks food, wondering if she needs to learn more about recipes and a complete diet. His family spends at least Rwf 2000 every year on drugs to treat their children’s intestinal worms. Nurses at Nyamagabe Health Centre in Nyamagabe District of the Southern Province of the country said that intestinal worms are the second most frequent problem of patients, after respiratory disease. The same situation is found at Kigeme Health Centre, another hospital in Nyamagabe District. “A lot of sensitization on health education is still needed in Rwanda,” said Etienne Hakizimana who has been a nurse at the Nyamagabe Health Centre since 1979. He says government needs a strong strategy to sensitize people about hygiene to decrease the risk of contamination. This is what the government has started doing. Last year it launched a program to deal with all neglected tropical diseases, including intestinal worms. The first step, according to Malick Kayumba, was to figure out where the problem is. Kayumba is the information officer for Access Project, a Columbia University program that is helping the Ministry of Health combat tropical diseases. Kayumba said the research on intestinal worms is almost done. The government plans a countrywide sensitization and mass treatment against intestinal worms before the end of this year. Even though the research is not finished, it is clear that the problem is enormous. “You can go in schools and find that 100 per cent of the children are all infected and this has huge consequences,” warns Kayumba . Contact: kwirwa@gmail.com